Journal Watch 15/5/2025

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including bypass better LSG for MACE outcomes, post-BMS medication, single-fire stapler reduces GERD rates, compliance and outcomes of semaglutide after BMS and the Obesity Association published weight stigma and bias standards, and more (please note, log-in maybe required to access the full paper).

Major Adverse Cardiac Events After Gastric Bypass vs Sleeve Gastrectomy

gastric bypass was associated with lower rates of MACE than sleeve gastrectomy over a follow-up period of up to 11 years, according to researchers from Switzerland.

Published in JAMA Surgery, they compared the risk of MACE among individuals undergoing gastric bypass or LSG. From 39 067 patients, 30 270 patients (77.5%) underwent gastric bypass and 8798 patients (22.5%) underwent LSG. The primary outcome of 4-point MACE, including acute myocardial infarction, ischemic stroke, hospitalizations for heart failure and all-cause mortality.

After weighting, over a median (IQR) follow-up of 5.1 years (2.6-7.6), the primary outcome occurred in 577 patients in the gastric bypass group (1.9%) and 264 patients in the sleeve gastrectomy group (3.0%), with incidence rates of 3.96 and 5.10 per 1000 patient-years, respectively (hazard ratio [HR], 0.75; 95% CI, 0.64-0.88).

There were lower rates of acute myocardial infarction (HR, 0.63; 95% CI, 0.46-0.86) with no differences were observed in ischemic stroke, hospitalisation for heart failure and all-cause mortality.

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Medication Use Before and After Different Bariatric Surgery Procedures: Results from a Population-Based Cohort Study

Bariatric surgery procedures shows robust reductions in the use of glucose, blood pressure and lipid-lowering drugs at 3 years follow-up, suggesting benefits of surgery on both quality of life and healthcare costs, according to Italian researchers.

Writing in Obesity Surgery, they evaluated the effect of different metabolic and bariatric surgery interventions on the use of medications to treat chronic conditions. During the period 2010 to 2020, 19,450 patients (22.5% males, 13.5% with diabetes) underwent a metabolic and bariatric surgery procedure.

Compared to LSG, the reduction in the use of glucose-lowering drugs was greater following GB (reduction at 3 years: 59 vs 65%, p-interaction < 0.001) and lower following LAGB (59 vs 25%, p-interaction < 0.001). There was a significant reduction in lipid-lowering drug use following LSG and GB (3-year reduction: 21 and 50%, p-interaction < 0.001), and in psychiatric drug use following LSG, GB, and LAGB (with no difference between groups).

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Does Stapling Platform Influence Robotic Sleeve Gastrectomy

Single-fire stapler use may enhance postoperative outcomes in LSG by reducing rates of de novo GERD without impacting weight loss, according to US researchers.

Published in Obesity Surgery, the study compared postoperative outcomes using a single-fire stapler versus a multiple-fire linear stapler, with a focus on postoperative de novo GERD. In total, 257 patients who underwent consecutive robotic assisted sleeve gastrectomy between 2016 and 2023 with either multiple fires of a linear stapler (n=201) or a single-fire linear stapler (n=56).

Patients in the single-fire group were noted to have a significantly lower rate of postoperative reflux (7.1% vs. 26.4%) and a decreased incidence of de novo reflux (1.8% vs. 10.9%). Multivariable analysis demonstrated that single-fire stapler use increased the likelihood of not developing postoperative GERD (odds ratio: 8.4, 95% confidence interval: 2.8–32.5).

They noted was no significant difference in operative time, and postoperative length of stay may be decreased.

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1-year Compliance and Outcomes of Semaglutide use in Patients With or Without Previous History of Bariatric Surgery

An international team of researchers has reported patients who underwent RYGB tended to lose more weight with semaglutide than naïve BMS patients.

Writing in the Annals of Surgery, they investigated weight loss outcomes of semaglutide in a real-world setting, specifically in patients who have undergone BMS. A retrospective series of patients with obesity prescribed semaglutide. Primary endpoints were compliance and percentage total weight loss (%TWL) within 1 year of semaglutide prescription, with further evaluation of weight loss in those with previous history of MBS.

The average [SD] %TWL at 1 year among all patients prescribed semaglutide was 8.8% [10.5]. Of 1,072 patients prescribed semaglutide, 199/1072 (18.6%) did not start semaglutide mainly due to access issues, and 268/1072 (25%) discontinued it within 1 year primarily due to patient factors and side effects.

In those with history of MBS, %TWL was higher in patients who underwent RYGB, but not sleeve gastrectomy, compared to no MBS history (13.6% [10.3] vs. 10.1% [9.6]; P=0.022). Furthermore, %TWL with semaglutide was less in those with BMI>40, than those with BMI<40.

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Weight Stigma and Bias: Standards of Care in Overweight and Obesity—2025

The Obesity Association, a division of the American Diabetes Association (ADA), has published ‘Weight Stigma and Bias: Standards of Care in Overweight and Obesity—2025, along with the "Introduction & Methodology" section in BMJ Open Diabetes Research & Care. The publication extends the ADA's process and expertise in developing trusted, evidence-based guidelines to obesity care, offering comprehensive standards to reduce weight stigma and improve care for people living with overweight and obesity

Key recommendations include:

• Training: All health care professionals and staff should receive ongoing education on weight bias and stigma beginning in early training and continuing throughout their careers.

• Inclusive clinical environments: Clinics should be equipped with appropriate furniture, equipment, and private accommodations that support people of all sizes.

• Person-centred communication: Health care professionals are urged to use respectful, non-judgmental language and to ask permission before discussing weight-related issues

• Shared decision-making: Health care professionals are encouraged to align care goals with a patient's values, recognizing health outcomes beyond just weight loss.

• Evidence-based interventions: The guidelines support multicomponent strategies, such as role-play, self-reflection, and patient engagement, to reduce implicit and explicit bias effectively.

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